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Gabrielli L, Ghaderi S, Almeida MCC, Goes E, Gnoatto C, Almeida L, Menezes GMS, dos-Santos-Silva I, Aquino EML. Racial differences in mammographic density in Brazil: implications for mammographic screening. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Mammographic density (MD)-the amount of radio-dense fibroglandular tissue seen on a mammogram - is a stronger biomarker of susceptibility to breast cancer and a major determinant of the sensitivity of mammographic screening. This study examined for the first time racial differences in MD in Brazil.
Methods
555 women (215 from the Longitudinal Study of Adult Health - ELSA-Brasil and 340 users of the Unified Health System - SUS) in Bahia were enrolled into the study. Participants completed an interview, had their heights and weights measured, and underwent a 2-view (cranio-caudal (CC) and medio-lateral-oblique (MLO)) digital mammography of each breast. MD was measured on the left MLO image using the semi-automated Cumulus software, and expressed as the percentage (PMD) of the breast area occupied by fibroglandular tissue. Linear regression models were fitted to assess ethnicity-PMD associations adjusting for age at mammography, body mass index (BMI) and reading batch (minimally-adjusted) and further for socio-economic and reproductive variables.
Results
The study population comprised 95 White (W), 270 Brown-mixed (Bm) and 169 Black (B) women, with a mean age at mammography of 58 (SD = 5.4) years. 63% W, 69% Bm and 49% B women had low educational level; 24% W, 47% Bm and 31% B women had ≥4 children. Minimally-adjusted analysis showed that relative to W women, PMD was 23% (1.23; 95% CI 1.04-1.45) higher in Bm and 4% (1.04; 0.89-1.21) higher in B; however, further adjustment for socio-economic and reproductive variables attenuated the racial differences (fully-adjusted model: 16% (1.16; 0.96-1.40) and 9% (1.09; 0.92-1.29) for Bm and B, respectively.
Conclusions
The racial differences in PMD were mainly accounted by ethnic differences in socio-economic and reproductive-related factors.
Implications Further studies should examine whether racial differences in PMD in Brazil lead to racial differences in false negative and interval cancer rates of mammographic screening.
Key messages
In Brazil, ethnic differences in socio-economic and reproductive-related factors are responsible for racial differences in mammographic density. More research is needed to address racial differences in breast cancer risk in Brazil.
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Affiliation(s)
- L Gabrielli
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
| | - S Ghaderi
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - M C C Almeida
- Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz - Fiocruz, Salvador, Brazil
| | - E Goes
- Centro de Integração de Dados e Conhecimento para a Saúde, Fundação Oswaldo Cruz - Fiocruz, Salvador, Brazil
| | - C Gnoatto
- Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil
| | - L Almeida
- Cican - Centro Estadual de Oncologia, Secretaria de Saúde do Estado da Bahia, Salvador, Brazil
| | - G M S Menezes
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
| | | | - E M L Aquino
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
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Pescarini JM, Craig P, Allik M, Amorim L, Ali MS, Smeeth L, Barreto ML, Leyland A, Aquino EML, Katikireddi SV. The Brazilian conditional cash transfer program and cardiovascular mortality: a data linkage study. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.1418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Conditional cash transfer programmes (CCTs) make monetary transfers to poor families conditional on health check-ups and/or education attendance. CCTs have been key in reducing poverty and improving child and maternal health in low- and middle-income countries (LMICs) but their impact on cardiovascular mortality have not been studied. We aimed to evaluate the effect of the CCT Bolsa Familia Program (BFP) on premature all-cause and cardiovascular mortality in Brazil.
Methods
The 100 Million Brazilian Cohort combined information about individuals applying for social programmes, the BFP and mortality data. We analysed ∼8 million individuals aged 30-69 who applied from 2011 to 2015. We calculated inverse probability weights (IPW) for the probability to receive BFP based on baseline observed characteristics (age, education, race, geographical location, household characteristics and year of application). Individuals were followed until they reached 70 years of age, died by any cause, or until 31st Dec 2015. We used Poisson regression (with person-years as the offset) and IPWs to compare BFP recipients to a comparable control population. Females and males were analysed separately.
Results
By following individuals for up to 4 years, 43,562 deaths by all-causes occurred among 4,197,658 females and 69,209 deaths among 3,672,393 males. Female BFP beneficiaries had approximately 60% lower all-cause mortality (IRR=0.40;95%CI=0.37-0.42) and CVD mortality (IRR=0.42;95%CI=0.37-0.47) than non-beneficiaries. Males who are BFP beneficiaries had ∼50% lower all-cause (IRR=0.53;95%CI=0.52-0.55) and 60% lower cardiovascular mortality (IRR=0.40;95%CI=0.38-0.42) than non-beneficiaries.
Conclusions
BFP, the world's largest CCT, may substantially decrease premature mortality. CCTs might have important implications for the growing burden of non-communicable diseases, with impacts potentially due to improved nutrition, socioeconomic conditions and improved primary care access.
Key messages
The Brazilian CCT, a widely recognized programme for poverty alleviation, have showed to be associated with lower overall and cardiovascular premature mortality in both women and men. Other countries, particularly LMICs, may learn from the health benefits of CCTs and should consider its potential large effect on mortality when planning austerity policies.
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Affiliation(s)
- J M Pescarini
- The Center for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil
| | - P Craig
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - M Allik
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - L Amorim
- Institute of Mathematics and Statistics, Federal University of Bahia, Salvador, Brazil
| | - M S Ali
- The Center for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil
- Department of Non-Communicable Disease Epidemiology, LSHTM, London, UK
| | - L Smeeth
- Department of Non-Communicable Disease Epidemiology, LSHTM, London, UK
- Health Data Research, London, UK
| | - M L Barreto
- The Center for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
| | - A Leyland
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - E M L Aquino
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
| | - S V Katikireddi
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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Patrão AL, Aquino EML, Almeida MC, Matos SMA. Psychosocial factors associated with a healthy lifestyle in Brazilian adult women. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
It has been estimated that over 50% of the premature deaths occurring in Western countries can be attributed to causes rooted in lifestyle. In turn, leading a healthy lifestyle has also been associated with a wide range of psychosocial factors. Today, it is known that these differ among men and women. The present article aimed to identify the psychosocial factors associated with healthy lifestyles in women from the ELSA-Brazil cohort, the largest study concerning adult health conducted in Brazil.
Methods
This cross-sectional study was conducted using ELSA-Brasil baseline data, collected between 2008-2010. All included individuals were aged between 35 and 74 years at the time of voluntary recruitment. The ELSA-Brasil cohort has 8,218 women, both currently working and retired, from six public higher education and research institutions. Data were collected using the ELSA-Brasil questionnaire, a multidimensional instrument encompassing a range of topics. The lifestyle indicator was constructed by summing the scores attributed to four different behaviors (smoking, excessive alcohol consumption, inadequate nutrition and insufficient physical activity).
Results
Among women of the ELSA-Brasil, the following factors are associated with a healthier lifestyle: an age of 50-59 years (OR = 1.41; IC95% 1.24-1.61); age 60 years or older (OR = 2.21; IC95% 1.79-2.72); race/skin color Asian (OR = 2.29; IC95% 1.57-3.36), white/Caucasian (OR = 1.57; IC95% 1.36-1.81) or mixed-race (OR = 1.24; IC95% 1.07-1.44); a high-school equivalent (secondary) level of education (OR = 1.31; IC95% 1.09-1.57) or university degree (tertiary) (OR = 1.89; IC95% 1.55-2.29); being retired (OR = 1.33; IC95% 1.12-1.59); the self-perception of health status as good/very good (OR = 1.27; IC95% 1.12-1.45).
Conclusions
These findings should contribute towards preventing chronic non-communicable in adult women in Brazil and in other similar settings.
Key messages
Socio-demografic factors, such as age, race, education and retirement, influence the lifestyle of Brazilian women. Psychological factors, such as self-perception of health status, influence the lifestyle of Brazilian women.
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Affiliation(s)
- A L Patrão
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
| | - E M L Aquino
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
| | - M C Almeida
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Brazil
| | - S M A Matos
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
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